Anterolateral Fixation in LLIF (original) (raw)

2016

Abstract

Lateral lumbar interbody fusion (LLIF) permits the insertion of a wide footprint interbody cage that optimizes cage-endplate interface, restores disc height, and provides indirect neural decompression and correction of sagittal/coronal deformity. The use of supplemental internal fixation in LLIF provides higher fusion rates, facilitates deformity correction and maintains correction until fusion. Importantly, fixation reduces the risk of cage subsidence that can have serious consequences including loss of indirect decompression requiring revision surgery. Factors influencing the need for supplemental lateral or posterior fixation in LLIF include bone density, degree of facet arthropathy, coronal or sagittal imbalance, radiographic or clinical instability, pars defects, spondylolisthesis, cage width, number of proposed levels, presence of an adjacent fusion, intraoperative vertebral endplate injury during cage insertion or endplate preparation, and planned or unplanned ALL rupture. Biomechanical data indicates improved stability of the spinal segment with lateral fixation, posterior fixation such as pedicle screws, facet screws, cortical screws and interspinous clamps, or a combination of both lateral and posterior fixation. However, bilateral pedicle screw-rod fixation remains the gold standard. In LLIF supplementary fixation is indicated to avoid subsidence, add stability, or correct deformity. Instrumentation is recommended in all patients with osteoporosis, radiographic or clinical instability and intraoperative unplanned events such as endplate injury or ALL rupture.

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